Anteo Bradaric

Large intracoronary thrombus burden during percutaneous coronary intervention (PCI) for acute coronary syndrome (ACS) remains technically challenging when conventional manual aspiration is ineffective or dedicated thrombectomy systems are unavailable, unsuitable, or undeliverable. Routine aspiration thrombectomy is not guideline-supported, but selective bail-out thrombus-removal strategies remain relevant in refractory thrombus-rich PCI. This contemporary narrative review, supplemented by six retrospective single-center clinical examples, describes off-label guide-extension catheter (GEC)-assisted thrombus aspiration and places it within the current thrombectomy landscape, including manual aspiration catheters, sustained mechanical aspiration platforms, and stent-retriever-based systems. The heterogeneous examples, predominantly involving the right coronary artery, are educational and hypothesis-generating only: they illustrate procedural mechanics, patient selection, technical pitfalls, and risk mitigation, but do not provide efficacy or safety evidence. GEC-assisted aspiration may be considered when bulky proximal thrombus cannot be captured by smaller catheters or when a GEC can be positioned coaxially near the thrombus face under uninterrupted negative pressure. The technique remains operator-dependent, off-label, and anatomically constrained and should be regarded as a contingency maneuver rather than an alternative to purpose-built systems with more formal device-specific evaluation. Prospective registries and comparative studies are required before efficacy, safety, or relative value can be established.

Large intracoronary thrombus burden during percutaneous coronary intervention (PCI) for acute coronary syndrome (ACS) remains technically challenging when conventional manual aspiration is ineffective or dedicated thrombectomy systems are unavailable, unsuitable, or undeliverable. Routine aspiration thrombectomy is not guide-line-supported, but selective bail-out thrombus-removal strategies remain relevant in refractory thrombus-rich PCI. This contemporary review of the literature on this unmet need, supplemented by six "real-world" single-center clinical examples, describes off-label guide-extension catheter (GEC)-assisted thrombus aspiration and places it within the contemporary thrombectomy landscape, including manual aspiration catheters, sustained mechanical aspiration platforms, and stent-retriever-based systems. The heterogeneous examples, predominantly involving the right coronary artery, illustrate procedural mechanics, patient selection, technical pitfalls, and risk mitigation, however, they do not provide efficacy or safety evidence. GEC-assisted aspiration may be useful when bulky proximal thrombus cannot be captured by smaller catheters or when a GEC can be po-sitioned coaxially near the thrombus face under uninterrupted negative pressure. Therefore, the technique remains operator-dependent, off-label, and anatomically con-strained. It should be regarded as a contingency maneuver rather than an alternative to purpose-built systems with more formal device-specific evaluation. Prospective registries and comparative studies are required before efficacy, safety, or relative value of this approach can be established.

Acutely decompensated heart failure is one of the leading causes of hospitalisation worldwide, with a significant majority of these cases attributed to congestion. Although congestion is commonly mistaken for volume overload, evidence suggests that decompensation can occur without significant water accumulation, being attributed to volume redistribution. Yet, the distinction between intravascular and extravascular congestion in heart failure often blurs, as patients frequently exhibit overlapping features of both, and as patients may transition between phenotypes over time. Considering that differentiation between intravascular and extravascular congestion can lead to different management strategies, the aim of this review was to delineate the pathophysiological nuances between the two, as well as their correlation with clinical, biochemical and imaging indices.

Primarily a consequence of sedentary lifestyle, atherosclerosis has already reached pandemic proportions, and with every year the burden of it is only increasing. As low-density lipoprotein cholesterol (LDL-C) represents a crucial factor in atherosclerosis formation and progression, stringent lipid-lowering therapy could conceivably be the key to preventing the unfavorable outcomes that arise as a consequence of atherosclerosis. The use of statins in lipid-lowering is often burdened by adverse events or is insufficient to prevent cardiovascular events as a monotherapy. Therefore, in the present review, the authors aimed to discuss the underlying mechanisms of dyslipidemia and associated atherosclerotic cardiovascular disease (ASCVD) and preclinical and clinical trials of novel therapeutic approaches to its treatment, some of which are still in the early stages of development. Apart from novel therapies, a novel change in perspective is needed. Specifically, the critical objective in the future management of ASCVD is to embrace emerging evidence in the field of atherosclerosis, because clinicians are often burden by common practice and personal experience, both of which have so far been shown to be futile in the setting of atherosclerosis.

Uma recente diretriz da Sociedade Europeia de Cardiologia (ESC) para o manejo de pacientes com síndromes coronarianas agudas (SCA) sem elevação persistente do segmento ST (SCASSST) não recomenda o pré-tratamento de rotina com um antagonista do receptor P2Y12 em pacientes nos quais a anatomia coronária é indeterminada e o manejo invasivo precoce está planejado (recomendação de classe III, nível de evidência A). A justificativa para tal recomendação foi baseada principalmente nos resultados obtidos de dois grandes estudos randomizados, ACCOAST e [...] Uma recente diretriz da Sociedade Europeia de Cardiologia (ESC) para o manejo de pacientes com síndromes coronarianas agudas (SCA) sem elevação persistente do segmento ST (SCASSST) não recomenda o pré-tratamento de rotina com um antagonista do receptor P2Y12 em pacientes nos quais a anatomia coronária é indeterminada e o manejo invasivo precoce está planejado (recomendação de classe III, nível de evidência A). A justificativa para tal recomendação foi baseada principalmente nos resultados obtidos de dois grandes estudos randomizados, ACCOAST e

A spontaneous coronary artery dissection (SCAD) during the postpartum period is a serious medical emergency and the most important non-atherosclerotic cause of coronary artery disease (CAD) in this population. While conservative management is recommended in most SCAD scenarios, cases complicated by hemodynamic instability or cardiogenic shock are particularly challenging and might be amenable only with invasive percutaneous or cardiothoracic surgical management. Herein, we present a case of a 35-year-old otherwise healthy woman that suffered an intense emotional stress event and was subsequently admitted with crushing chest pain to the emergency department. The initial electrocardiogram showed dynamic changes suggesting anterolateral ST-elevation myocardial infarction. She gave birth to a healthy child 3 months before the current presentation. Diagnostic angiography found no occlusive CAD but instead an extensive intramural hematoma originating from the left main artery dissection and extending to the whole left coronary circulation was observed. Hemodynamic instability and hypotension soon followed, and the patient went into cardiogenic shock. The heart team opted for conservative and supportive intensive care management without surgical or percutaneous intervention. This decision ultimately led to the successful extubation of the patient and the achievement of hemodynamic stability. The patient was eventually safely discharged home without any permanent disability.